NHS Glos. CCG: Community Diabetes Service

Kirstie Tew, MSc., Abby Barton, BSc., & Sophie Middleton

Executive Summary

Background

Physical activity is fundamental to the treatment of type 2 diabetes and should be prescribed by a healthcare professional at initial diagnosis, prior to pharmaceutical medications (Nathan et al., 2009), and should continue throughout the management phase of the condition (Duclos et al., 2015; Andrews et al., 2011). The Community Diabetes Service is made up of a team of specialist nurses, dietitians and diabetes educators/facilitators supporting people with type 2 diabetes to better manage their condition. KiActiv^® Health has been made available for the Community Diabetes Service to refer people to as a valuable tool to support individuals in local communities to self-manage their type 2 diabetes and create sustainable habits to benefit their health and wellbeing.

Innovation

KiActiv^® Health is a personalised and guided online behaviour change service that empowers participants to optimise everyday physical activity in the context of their condition. KiActiv^®’s patented technology evaluates minute-by-minute physical activity data from a validated wearable monitor, which is displayed instantly in the user’s personalised online dashboard, and is available 24/7 to provide meaningful and actionable feedback. Patients are also supported remotely by phone calls with a dedicated KiActiv^® Mentor at 6 key time points during the 12-week programme, to help them build an understanding of the value of their daily activities and the confidence to plan, monitor and improve. At the end of the 12-weeks, the patients retain access to their personal dashboard and activity monitor, enabling them to continue their self-management using the technology if desired.

Purpose/objective

To provide an accessible service through community care pathways to enable patients diagnosed with type 2 diabetes to improve self-care through the optimisation of their everyday physical activity.

Methodology

Eligible patients were invited to participate in KiActiv^® Health via their local Community Diabetes Service. Enrolled patients were sent a wearable activity monitor, before participating in the 12-week KiActiv^® Health programme. They were supported at key time points throughout by a trained KiActiv^® Mentor. Data was analysed from a range of sources: the KiActiv^® Health platform, KiActiv^® Mentor calls, and a self-administered online questionnaire. 

Key Findings

• Demographics: 13 patients started KiActiv^® Health (9 females, 4 males), average age = 57 years, average body mass index (BMI) = 36.7kg/m².
• Completion: 7 patients (54%) (5 females, 2 males) have completed the 12-week programme. 5 patients (39%) are currently within the 12-weeks.
• Engagement: The use of the technology was excellent and included 92% of days being classed as having complete data sets.
• PROMS: A self-administered online questionnaire was completed on completion of the 12-weeks of KiActiv^® Health.
  • 100% of respondents felt that their understanding of physical activity had improved as a result of participation in KiActiv^® Health
  • 100% of respondents felt confident that they could manage their physical activity for their overall health now and in the future
  • 100% of patients felt that KiActiv^® Health had benefitted them in some way
  • 100% of patients stated that they would recommend KiActiv^® Health to a family member or friend
  • Patient reported benefits included:
    • An increased awareness of all movement, not just exercise
    • Understanding the accessibility of everyday physical activity, and finding more enjoyment in daily activities
    • Improved pulmonary symptoms (i.e., reduced breathlessness, improved lung capacity)
    • Benefits to other aspects of lifestyle such as improved sleep, feeling fitter, stronger and more energised
    • The ability to set realistic goals, self-manage, and improve daily physical activities
    • A sense of control around how everyday physical activities affect their health and wellbeing, which has led to an improvement in physical and mental health, as well as overall QoL
• Physical Activity Data:
  • 100% of patients improved their physical activity in 1+ dimensions
  • 100% of patients improved their physical activity in 3+ dimensions
  • 100% of patients improved their physical activity in 4+ dimensions
  • The average increases in physical activity from baseline (i.e., physical activity dose) across an average of 70 complete days were:
    • Non-Sedentary Time: +43hrs 27mins (+20%)
    • Moderate Activity: +17hrs 12mins (+33%)
    • Moderate Bouts: +14hrs 51mins (+332%)
    • Calorie Burn: +7,556kcals (+4%)

As a result of the physical activity improvements, 100% of the group achieved physical activity levels shown to reduce HbA1c by 0.89%, improvements that are comparable with diet and drug interventions (Umpierre et al., 2011).

Conclusion:

It is widely accepted that physical activity is an effective method for managing type 2 diabetes and is recommended in the NICE Guidelines (NICE NG17, 2015; NICE NG28, 2015). Physical activity has been shown to directly improve glycaemic control (Kujala, 2009) as well as reducing body weight, which is crucial for the control of type 2 diabetes (Wilding, 2014). Patients were able to improve physical activity levels by an amount which has been shown to reduce HbA1c by 0.89%, meaning that the positive impacts felt by participants in this cohort are comparable to those on diet and drug interventions (Umpierre et al., 2011).

KiActiv^® Health increased self-management skills and participants received person-centered care along with tailored individual advice on optimising their daily physical activity to improve self-management of their type 2 diabetes and reduce the impact of any comorbidities or related complications. The remote nature of KiActiv^® Health overcomes the travel barrier, ensuring participants are supported from the safety of their own homes. Not only is this particularly pertinent due to ongoing COVID-19 restrictions, reducing our reliance on transport to receive healthcare will also reduce carbon emissions, supporting the vision for a greener, healthier planet. Ultimately, KiActiv^® Health provides support to those diagnosed with type 2 diabetes to optimise their physical activity for the good of their health, which can help to reduce the burden of further associated health complications in the future.

2nd December 2021